MEMORIAL SLOAN NOMOGRAM - PROSTATE CANCER SURVIVAL

bob33462

FYI - Interesting information - I input my information and it comes out to me having a 96% chance of living 15 years post surgery - Nothing was stated about additional treatments, RT or Hormones. For me, something to think about as 15 years brings me out to 84 years old!


Our post-radical prostatectomy nomogram can be used by patients after their surgical treatment for prostate cancer. Using a dynamic statistical formula, this nomogram predicts the probability of remaining cancer recurrence-free at two, five, seven, and ten years following surgery. This nomogram also predicts 15-year cancer-specific survival, meaning the likelihood that you will NOT die of prostate cancer within 15 years following surgery.

post-radical prostatectomy nomogram Link

https://www.mskcc.org/nomograms/prostate/post-op

VascodaGama

MSKCC Monogram

Bob, You are right. However these data used to predict results is from survivors that continued treatment. I am one of them. I had surgery in 2000 at the age of 50, unfortunately did not experience remission (post op PSA=0.18), in 2006 at a PSA=3.80 had Radiation (nadir PSA=0.05), in 2010 at PSA=1.00 started hormonal therapy (IADT). Along my journey I gave high considerations to quality of life over treatment. Today I am 66 and am enjoying life.

I hope your case is better than mine. I hope you manage to get (PSA<0.06) remission and that further treatment is done at the right timing, if any.

Best,

VG

bob33462

VascodaGama said:

MSKCC Monogram

Bob, You are right. However these data used to predict results is from survivors that continued treatment. I am one of them. I had surgery in 2000 at the age of 50, unfortunately did not experience remission (post op PSA=0.18), in 2006 at a PSA=3.80 had Radiation (nadir PSA=0.05), in 2010 at PSA=1.00 started hormonal therapy (IADT). Along my journey I gave high considerations to quality of life over treatment. Today I am 66 and am enjoying life.

I hope your case is better than mine. I hope you manage to get (PSA<0.06) remission and that further treatment is done at the right timing, if any.

Best,

VG

MSKCC Monogram

VG -

Yes, if my post op PSA never is negative decisions will have to made right away.

I believe, the Sloan 15 year monogram included data on those post op patients with and without secondary treatment. Are you sure it only included men receiving treatment? I'm assuming they were also following men that were having PSA periodically checked, not just those receiving secondary treatment.

If I am correct, then had the Sloan outcome only included people with secondary treatments those monogram percentages would have been higher.

 

VascodaGama

How far can we trust the basic data and its source

Bob,

I think you are correct. The monogram predicts the status at each mile stone up to 10 years using data from those with PSA values lower than 0.2 ng/ml (predicting free biochemical recurrence). I am not so sure about the survival period (no death due to PCa in 15 years) estimated in percentage. It may include also those patients that would recurred and followed a salvage treatment. Otherwise the total number of patients (from the same cohort) used to create the mathematical formulas would be very low in high risk cases (high Gleason patherns, evident metastases lymph nodes involvement).

I believe that these kind of monograms (MSKCC and others) include the data of patients collected from hospitals, clinics and private doctors that have followed (in person) their patients during the first 3 to 5 years. The estimations are then done using mathematic regression tables without any specific check, therefore with high possibilities of being erractic. By experience, I have participated in such sort of collecting data (trials) done by JH during a 5 year period, to check on the benefit of taking a daily aspirin. But they only strictly followed my case contacting me personally in the first two years (free consultations). The added period was done with predictive mathematics, and some details sent from me annually via email.

Another fact that could influence the above basic data is the norms used at the source from where the data is collected. Some instituitions (and particular doctors) do not operate on risky cases to assure high percentages of successful outcomes in their corriculum. I read before about this practice used at JH and MSKCC.

My advice to you is to get a PSA test the soonest. You can do it privatly at a close laboratory. It is not expensive (approximately 25 Euros=$30) and it will mean alot in evaluating your next step, when comparing with the scheduled 3-month PSA.

Best

VG

 

Old Salt

A big ? to me

I have been wondering about these nomograms. Because the 15-year data are based on patients first treated 15 years ago, and because prostate cancer treatments have changed substantially over that time period, my feeling is that these data/nomograms are almost worthless for patients diagnosed today.

Or is my thinking wrong?

If so, please educate me.

 

Max Former Hodgkins Stage 3

Stats

I read a statistic recently from an authoritative source, some major cancer institute (I think it also was Sloan, but cannot recall for certain).  I do recall that the numbers pertained to the United States. It stated that the average new PCa patient, with newly discovered disease at metastatic Stage IV, who was yet to begin receiving initial treatment, has an average survival rate of over five years.

 Sloan has these predictive matrices for all forms of cancer. I suppose they are of some worth, but as Vasco so well notes, the test populations employed to gather the data can skew things radically.

By all accounts, PCa is among the most treatable of all common cancers, with among the longest survival rates.  Routinely, people with advanced pancreatic or brain tumors are told they have a few months. My brother's monther-in-law was diagnosed with pancreatic, and died four days later.  A statistical estimate of course is non-determanitive for any given individual; how long any given patient lives is not set by what some PhDs or statisticians put in a journal article. 

If ya gotta fight cancer, PCa is the way to do it !

max

Old Salt

bob33462 said:

WOULD NOT SAY WORTHLESS

Old Salt-

Good point If anything wouldn't you think the longevity would be higher? Better treatments and earlier detection would seem to increase life spans.

That said, do not see how much better my 96% odds of surviving 15 years withoud dying of prostate cancer could be. Do you?

Also, I am not sure they do not update the nomogram data as new results come in.

Bob

Good Points

I agree that 'almost worthless' is too strong.

I also agree that, considering improving therapies, life spans might actually be better than what the nomograms predict.

bob33462

Old Salt said:

A big ? to me

I have been wondering about these nomograms. Because the 15-year data are based on patients first treated 15 years ago, and because prostate cancer treatments have changed substantially over that time period, my feeling is that these data/nomograms are almost worthless for patients diagnosed today.

Or is my thinking wrong?

If so, please educate me.

 

WOULD NOT SAY WORTHLESS

Old Salt-

Good point If anything wouldn't you think the longevity would be higher? Better treatments and earlier detection would seem to increase life spans.

That said, do not see how much better my 96% odds of surviving 15 years withoud dying of prostate cancer could be. Do you?

Also, I am not sure they do not update the nomogram data as new results come in.

Bob

foamhand

5+ years is all my docs talk about

I'm stage 4 regional, and from what I've read most figures say if all goes well I have 5 years at least. My doctors talk in 5 yr terms but that's just a number they use as they don't know for sure. I could go 10 or more according to one site and new therapies are emerging all the time. Each person is different. I just wish I'd have caught this sooner. My doctor from a physical 2 years ago said he didn't believe in PSA as it was too unreliable and didn't order one.. Had he done one then, I might have been better off.

VascodaGama

Foamhand: Your comment applies to me too

Foamhand: Your comment applies to me too (and to many of our comrades). Does our doctor believe in the PSA?

At age of 45 (1994) my GP for 20 years (company's doctor for annual health check ups) started to check me for prostate cancer. It was his practice to include PCa in the screening program for those above 45. Every year the results were negative. But in the year 2000 (at 50 years old) my doctor wasn't at the check up day. A substituting doctor attended me instead, and such took me to comment that I was in the PSA screening program for prostate cancer.

This time the result was different. The PSA was 22.4 ng/ml. It was given to me three days later by my own GP. He was surprised and upset with the result but for me it meant nothing (???). What was the problem?
I was healthy, had no symptoms, full of energy and was successful in my professional life. I couldn't understand what annoyed him.

The fact is that he was of the group of doctors (in those times) that did not believe in the PSA so that his preferred screening test was the PAP test that measures prostatic acid phosphatase (common test at those times for Prostate health which is now replaced with the PSA around the world). He felt guilty for the many men he erroneously has tested with a negative to cancer result.

My PAP numbers were OK in all pre 5 years. From this first PSA result I was submitted to a series of other tests and exams (all negative) till a final sextant biopsy (all needles positive) diagnosed me with the bandit. In my regression calculations the cancer may have shown its face for the first time at my 46 years of age. Now it was too late already. The bandit escaped and hides somewhere. Never managed to take a picture of it. I become systemic.

As it may be incredible, the PSA is still today the only test for most of us that accurately (more or less) can "regulate" our status with the cancer providing information important in a treatment decision.

Best wishes in your journey,

VG

Max Former Hodgkins Stage 3

"Believe In"

foamhand,

My GP and I discussed PSA several times over the years, before I was diagnosed with PCa. He was always of the opinion that PSA testing is overused and causes unnecessary treatments.  I have always like his relaxed style.  He was internationally trained (best schools in the US and Switzerland), but I disagree regarding PSA.  I have no medical training, but feel his view is just counterintuitive and dismissive.  My PSA gradually drifted up each year, and I had symptoms of bad BPH, which flowmax helped, and it also led the doc to believe it accounted for the upward PSA drift, which is normal as men age anyway.

Anyway, I could not relax regarding the worry after my number went up about 1.5 in under a year, and went to a urologist.  Unlike my GP, she said my chart suggested that a biopsy be performed, which came back positive. I had it cut out within a few months, after speaking to a variety of doctors.  Luckily, the gland was just Stage 2.  But PSA results are what got me to the urologist.

Similiar talk has been underway with mamograms and breast cancer, some saying they are given too often.  I say that that is crap, and that if your wife is the one woman saved by an annual mamo, then you are pretty sure to feel it was a good thing to have.

For decades, I will occassionally (maybe a few times a year) get woozie and feel almost faint; hands shaking pretty hard.  I asked doc about hypoglycemia, but he said that in patients who are not diabetic or on diabetic meds, he "does not believe in it" (I am not a diabetic).  How can a doctor "not believe" in a condition with several diagnostic codes ? Can a doctor "not believe in heart disease ?" Or anything the choose to not believe in ?

PSA testing: a blessing to men.

max

Josephg

Absolutely Believe In

I could not agree with you more, Max.  My PSA increased from 2.3 to 5.2 over 4 years, and though my family doctor had the PSA test taken annually and observed the results, he did nothing about it.  And, I did not have any other urinary tract issues for which the rise in PSA could be attributed to.  Finally, after the PSA exceeded 5.0, he suggested that I consider seeing a Urologist.

The Urologist was no more than 5 seconds into the digital rectal exam, and he already had decided that he was going to perform a biopsy.  My biopsy was by no means pleasant, as I bled profusely for 3 hours after the biopsy, before he was able to stop the bleeding.  The biopsy came back 3+4=7, and after surgery, it was upgraded to 4+3=7, with the rest of the pathology being pT3a NO.

To those who say that the PSA test is not necessary, and results in too many unnecessary treatments, I say that they are entitled to their own opinions.  But do NOT make the PSA test unavailable to others who wish to have it (including not being effectively unavailable, due to lack of insurance coverage).  I would be more than happy to take ‘unnecessary’ and unpleasant tests, if there is a chance that cancer could be detected, and effectively dealt with earlier than later.  There is no question in my mind that if I had not taken the PSA tests, I would now be well on my way toward that early exit from life.

hopeful and optimistic

.

Agree there is no question in my mind that having regular PSA tests that can detect early-stage prostate cancer that can be effectively treated or closely monitored in an active surveillance program 

As you may be aware it has been a controversy in the last few years about PSA testing

New guidelines have recently been established that recommend less PSA testing

Mary medical professionals as well as non-professionals who have been stricken with this disease have actively protested to this new recommendation

Members of this board have been part of this protest

 

It is my belief that many men will now be diagnosed with more advanced Prostate Cancer than previously with consequences of difficult life changing treatments or a hard end life than before 

foamhand

A bird in the hand...

Well, I now feel that even if PSA (and its counterparts) are all we have, they should be used regardless and the upper limit should be lowered. If even one person can be caught earlier than I was and give them a better shot at a cure then it's worth it. For me, prostate biopsy was more of a mental challenge than what I actually experienced. Yes, it was an annoyance but not nearly as painful as I thought. Even if a biopsy comes back negative, It's still worth checking just like a colonoscopy. A bird in the hand is worth 2 in the bush as they say.

Swingshiftworker

While there is reason to believe that men have been unnecessarily TREATED for PCa because of early detection, I have no doubt that early and regular PSA detection is the ONLY means to prevent premature death because of PCa.  

There is no harm done if PSA testing is done early and regularly.  The same cannot be said of early and essentially unnecessary treatment, especially via surgery which is so often recommended to men with Gleason 6 biopsies whe just want the cancer removed -- by the quickest means possible -- w/o any clue about the risks of such treatment and the availblility of other treatment options such as active surveillence and the various less draconian and less harmful radiation treatments, most notably CyberKnife (aka SBRT). 

So, while I am a ferocious opponent of unnecessary PCa surgery, so am I an advocate of early and regular PSA testing for all men 50 and older (even younger if there is a history of PSA in the family).